Physiological time-series analysis using approximate entropy and sample entropy

Entropy, as it relates to dynamical systems, is the rate of information production. Methods for estimation of the entropy of a system represented by a time series are not, however, well suited to analysis of the short and noisy data sets encountered in cardiovascular and other biological studies. Pincus introduced approximate entropy (ApEn), a set of measures of system complexity closely related to entropy, which is easily applied to clinical cardiovascular and other time series. ApEn statistics, however, lead to inconsistent results. We have developed a new and related complexity measure, sample entropy (SampEn), and have compared ApEn and SampEn by using them to analyze sets of random numbers with known probabilistic character. We have also evaluated cross-ApEn and cross-SampEn, which use cardiovascular data sets to measure the similarity of two distinct time series. SampEn agreed with theory much more closely than ApEn over a broad range of conditions. The improved accuracy of SampEn statistics should make them useful in the study of experimental clinical cardiovascular and other biological time series.     

Voice disorders assessed by (cross-) Sample Entropy of electroglottogram and microphone signals

The quantitative analysis of vocal disorders by nonlinear signal processing methods has been extensively used in the last two decades. In this work, two algorithms for nonlinear time-series analysis, Sample Entropy and cross-Sample Entropy, are used on electroglottogram (EGG) and microphone (MIC) signals recorded from 51 normal and 80 dysphonic subjects, to obtain summary measures of voice disorders through SampEn and cross-SampEn indices. Such parameters quantify, respectively, the degree of irregularity (in the sense of self-dissimilarity) within a time-series and of asynchrony (in the sense of cross-dissimilarity) between two distinct time-series. The aims of this work are: to determine if statistically significant differences in terms of signal irregularity quantified by SampEn occur between normal and pathological subjects, investigating whether or not such differences can be equally seen in EGG and MIC; to assess if cross-SampEn reveals different degrees of asynchrony between EGG and MIC signals in the two groups. Results show that SampEn in pathological subjects is higher than in normal subjects for both EGG and MIC time-series, with a statistically significant difference detectable from both signals (Pe < 10^?4 for EGG and Pe < 10^?7 for MIC). Cross-SampEn exhibits a statistically significant difference too, showing a higher degree of cross-dissimilarity between EGG and MIC time-series for pathological subjects (Pe < 10^?4). In conclusion, SampEn and cross-SampEn well quantify the increase of complexity of both EGG and MIC signals and the decrease of their cross-similarity in presence of vocal disorders. Thanks to the complementarity of nonlinear indicators to the traditionally considered linear ones, SampEn and cross-SampEn appear as suitable candidates to enter the pool of approaches to investigate speech pathologies and to obtain potentially new insights on their nature.     

心脏对异丙肾上腺素反应性与心搏间期近似熵的关系

在正常新西兰兔测得搏间期近似熵较大,阿托品阻断后心搏间斯近似熵下降的基础上,观察兔心脏在上述两种状态下对异丙肾上腺素反应的差距。结果显示：在正常时,心脏对0．2μg/kg,0．4μg/kg,0．6μg/kg,异丙肾上腺素的反应性均强于应用阿托品后,并有显著差异P＜0．05,待阿托品作用部分消除后,心脏对异丙肾上腺素的反应性也部分恢复。表明心搏间期复杂性越大对异丙肾上腺素反应越敏感,支持“非周期敏感”是可兴奋细胞、组织或器官基本反应特征的假说。     

贮存式自体成分输血对胃肠肿瘤根治术患者T淋巴细胞亚群、血液流变学和预后的影响

摘要 目的：研究贮存式自体成分输血对胃肠肿瘤根治术患者T淋巴细胞亚群、血液流变学以及预后的影响。方法：选取2016年12月~2017年12月我院收治的95例行胃肠肿瘤根治术的胃肠肿瘤早期患者作为研究对象。按随机数表法分为A组（n=47,贮存式自体成分输血）和B组(n=48,异体成分输血)。比较两组患者血常规指标[红细胞计数(RBC)、血红蛋白（Hb）、血细胞比容（Hct）]、免疫功能指标（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）、血液流变学指标[红细胞沉降率、平均血液黏度、红细胞刚性指数及红细胞变形指数]的变化。随访患者2年,采用Kaplan-Meier曲线分析两组预后情况。结果：术前至术后7 d 时间段A组的CD3⁺、CD4⁺水平及CD4⁺/CD8⁺呈先降低后升高趋势,且术后7 d已恢复至术前水平;B组术后1 d、3 d、7 d的CD3⁺、CD4⁺水平及CD4⁺/CD8⁺明显低于A组(P＜0.05),两组CD8⁺水平相比无差异(P＞0.05) 。两组术后7 d的RBC、Hct、Hb分别较输血前下降（P＜0.05）,但两组间比较差异无统计学意义(P＞0.05);两组患者术后7 d的红细胞沉降率均升高,但A组低于B组(P＜0.05) ,两组患者术后的红细胞变形指数、平均血液黏度和红细胞刚性指数比较无差异 (P＞0.05) 。Kaplan-Meier检验结果显示,A组较B组生存率明显升高（P＜0.05）。结论：贮存式自体成分输血对胃肠肿瘤根治术患者红细胞沉降率、细胞免疫功能的影响程度较异体成分输血减轻,且贮存式自体成分输血可以明显提高患者的术后生存率。     

Noise and complexity in human postural control: interpreting the different estimations of entropy

Background

Over the last two decades, various measures of entropy have been used to examine the complexity of human postural control. In general, entropy measures provide information regarding the health, stability and adaptability of the postural system that is not captured when using more traditional analytical techniques. The purpose of this study was to examine how noise, sampling frequency and time series length influence various measures of entropy when applied to human center of pressure (CoP) data, as well as in synthetic signals with known properties. Such a comparison is necessary to interpret data between and within studies that use different entropy measures, equipment, sampling frequencies or data collection durations.

Methods and Findings

The complexity of synthetic signals with known properties and standing CoP data was calculated using Approximate Entropy (ApEn), Sample Entropy (SampEn) and Recurrence Quantification Analysis Entropy (RQAEn). All signals were examined at varying sampling frequencies and with varying amounts of added noise. Additionally, an increment time series of the original CoP data was examined to remove long-range correlations. Of the three measures examined, ApEn was the least robust to sampling frequency and noise manipulations. Additionally, increased noise led to an increase in SampEn, but a decrease in RQAEn. Thus, noise can yield inconsistent results between the various entropy measures. Finally, the differences between the entropy measures were minimized in the increment CoP data, suggesting that long-range correlations should be removed from CoP data prior to calculating entropy.

Conclusions

The various algorithms typically used to quantify the complexity (entropy) of CoP may yield very different results, particularly when sampling frequency and noise are different. The results of this study are discussed within the context of the neural noise and loss of complexity hypotheses.     

七氟烷与丙泊酚维持麻醉对合并冠心病腹腔镜胆囊切除术患者心功能、氧化应激和术后认知功能的对比研究

摘要 目的：对比七氟烷与丙泊酚维持麻醉对合并冠心病腹腔镜胆囊切除术（LC）患者心功能、氧化应激和术后认知功能的影响。方法：选取2020年3月~2022年4月在吉林大学第一医院乐群院区麻醉科行全麻下LC的98例合并冠心病的患者,按照随机数字表法将患者分为A组（n=49,丙泊酚维持麻醉）和B组（n=49,七氟烷维持麻醉）。对比两组麻醉效果、血流动力学相关指标[心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO₂）]、认知功能情况[简易智能精神状态量表（MMSE）评分]、心功能指标[心输出量（CO）、心脏指数（CI）、左室射血分数（LVEF）]、氧化应激指标[超氧化物歧化酶（SOD）、丙二醛（MDA）、总抗氧化能力（T-AOC）]和不良反应发生率。结果：B组的恢复自主呼吸时间、睁眼时间、拔管时间、定向力恢复时间均短于A组（P<0.05）。B组气腹后5 min、手术结束时SpO2、HR、MAP高于A组（P<0.05）。B组术后1 d、术后3 d MMSE评分高于A组（P<0.05）。B组术后1 d CO、CI、LVEF高于A组（P<0.05）。B组术后1d SOD高于A组,MDA、T-AOC低于A组（P<0.05）。两组不良反应发生率组间比较无统计学差异（P>0.05）。结论：与丙泊酚维持麻醉相比,七氟烷用于合并冠心病LC患者,有利于维持血流动力学稳定,减轻心功能、氧化应激损伤和术后认知功能障碍。     

Exenatide Therapy in Obese Patients With Type 2 Diabetes Mellitus Treated with Insulin

ObjectiveTo evaluate the effect of exenatide on clinical parameters in obese patients with type 2 diabetes mellitus whose hyperglycemia is not adequately controlled despite treatment with oral hypoglycemic agents and insulin.MethodsIn this retrospective analysis, clinical progress of 52 obese patients with type 2 diabetes treated with exenatide, 5 mcg twice daily, in an outpatient setting was reviewed. Treatment initiation was between September and December 2005. Mean follow-up period was 26 weeks. Thirty-eight patients took exenatide regularly (Group A); 14 patients discontinued exenatide because of insurance, personal, or economic reasons (Group B). Measurements at baseline and at follow-up included body weight; blood pressure; and levels of hemoglobin A_1c (HbA_1c), high-sensitivity C-reactive protein (CRP), and plasma lipids. Insulin dosage requirements were assessed.ResultsMean body weight (± standard error of the mean) decreased by 6.46 ± 0.8 kg (P < .001) in Group A and increased by 2.4 ± 0.6 kg in Group B (P < .001). In Group A, mean HbA_1c decreased by 0.6 ± 0.21% (P = .007), and the insulin dosage requirement decreased for rapid-acting and mixed insulins (P < .02). In Group A, means of the following parameters decreased: serum total cholesterol by 8.5 ± 3.3% (P = .03), triglycerides by 26 ± 7.6% (P = .01), systolic blood pressure by 9.2 ± 3.3 mm Hg (P = .02), and high-sensitivity CRP by 34 ± 14.3% (P = .05). These indices did not change in Group B.ConclusionExenatide effectively treats obese patients with type 2 diabetes on insulin, leading to weight loss and reduction in levels of HbA_lc, systolic blood pressure, triglycerides, and high-sensitivity CRP. (Endocr Pract 2007;13:444-450)     

限制性补液复合去甲肾上腺素对脓毒性休克患者血流动力学及氧代谢的影响

目的:探讨限制性补液复合去甲肾上腺素对脓毒性休克患者血流动力学及氧代谢的影响。方法:将62例脓毒性休克患者按照液体复苏策略随机分为限制性液体复苏(治疗组)和常规液体复苏(对照组),每组各31例。观察和比较复苏前后血流动力学指标、氧代谢指标的变化,记录两组低血压、弥散性血管内凝血(DIC)、多器官功能障碍综合征(MODS)、急性呼吸窘迫综合症(ARDS)的发生率及2周病死率。结果:治疗后1 h、3 h、6 h,两组患者CVP、MAP明显升高,HR明显下降(P0.05);治疗后3 h、6 h,治疗组MAP明显低于对照组(P0.05),而两组HR、CVP比较差异均无统计学意义(P0.05)。治疗后1 h、3 h、6 h,两组患者PaCO_2、PaO_2、SaO_2、PaO_2/Fi O_2均不同程度改善,治疗组治疗后3 h、6 h PaO_2、PaO_2/Fi O_2明显高于对照组(P0.05)。治疗后3 d,治疗组MODS的发生率较对照组显著降低(P0.05),而两组低血压、ARDS、DIC及2周病死率均无显著性差异(P0.05)。结论:限制性液体复合小剂量去甲肾上腺素对脓毒性休克患者有助于维持血流动力学稳定,改善全身氧代谢,减少并发症的发生,改善预后。     

喉罩与气管插管在呼吸衰竭患者院前和急诊急救中的应用效果比较

目的:探讨喉罩与气管插管在呼吸衰竭患者院前和急诊急救中的应用效果。方法:选择2016年1月至2018年5月由中国人民解放军第174医院急诊医学科出诊抢救的呼吸衰竭患者92例,所有患者根据通气方法的不同分为A组和B组。其中A组使用喉罩人工通气方法进行急救,共有47例,而B组则使用气管插管人工通气方法进行急救,共有45例,比较两组患者治疗前与治疗1 h后呼吸频率(RR)、心率(HR)以及血氧饱和度(SpO_2)等生命体征指标,对比喉罩与气管插管置入时间、一次性成功率、心肺复苏成功率情况,记录两组并发症发生情况。结果:两组患者治疗前HR、RR以及SpO_2比较差异无统计学意义(P0.05),两组患者治疗1 h后HR、RR均较治疗前降低,SpO_2较治疗前升高(P0.05),两组患者治疗1h后HR、RR以及SpO_2比较差异无统计学意义(P0.05)。A组的喉罩插管置入时间明显短于B组的气管插管置入时间,且A组插管一次性成功率明显高于B组,两组比较差异具有统计学意义(P0.05),而两组心肺复苏成功率比较差异无统计学意义(P0.05)。A组并发症发生率为2.13%(1/47),低于B组的并发症发生率13.33%(6/45),差异具有统计学意义(P0.05)。结论:喉罩通气与气管插管通气效果基本一致,但其操作更简单更安全,可缩短插管置入时间,提高一次性成功率,争取抢救时间。     

Effect of dexmedetomidine-induced anesthesia on the postoperative cognitive function of elder patients after laparoscopic ovarian cystectomy

ObjectiveTo investigate the effect of dexmedetomidine at maintenance dose on the postoperative function of elder patients after general anesthesia for laparoscopic ovarian cystectomy.MethodsWe enrolled a total of 96 elder patients who were admitted to this hospital for laparoscopic ovarian cystectomy under general anesthesia between March 2015 and March 2017, and divided them into two groups, Group A (n = 48) and B (n = 48). Patients in both groups received the same methods for anesthesia induction and maintenance drugs. At the beginning of operation, patients in Group A received the intravenous injection of dexmedetomidine (0.8 μg/kg) followed by maintenance dose [0.5 μg/(kg h)] to the end of operation, while those in Group B underwent intravenous injection of 0.9% normal saline at the same rate, during which blood pressure, heart rate, oxyhemoglobin saturation and dosage of anesthetics at T1 (5 min after being delivered into the operation room), T2 (immediately after anesthesia induction), T3 (immediately after intubation), T4 (immediately after operation), T5 (immediately after end of operation) and T6 (immediately after extubation). Then, the levels of NSE, IL-6, CRP and HMGB1 were compared between two groups at 24 h before the operation, at the end, 24 h, 3 d and 7 d after operation. Besides, we also compared the postoperative cognitive functions and incidence of adverse reactions at 1 d before, 1, 2, 3 and 7 d after operation through MOCA scales.ResultsAt T3, T4 and T6, comparisons of the average arterial pressure and heart rate showed that the differences between the two groups had statistical significance (p < .05). At the end of operation, and at 24 h, 3 d and 7 d after operation, we found that the levels of IL-6 and CRP in patients of two groups were all significantly elevated when compared with those before operation; at the end of operation and at 24 h and 3 d after operation, the levels of IL-6 and CRP in the Group B were higher than those in the Group A, and the differences had statistical significance (p < .05). At the end of operation and at 24 h and 3 d after operation, the levels of NSE and HMGB1 in two group were higher than those before operation, and a more significant elevation was identified in Group B with statistically significant differences (p < .05); at 7 d after operation, a decreasing trend was found in the level of HMGB1, which, however, remained higher than the preoperative level, and the level in Group B was still higher than that in Group A with statistically significant differences (p < .05). At 2 d after operation, we found that the scores of MOCA in the Group B were remarkably decreased in comparison with the scores in Group A with a statistically significant difference (p < .05). Moreover, the incidence rate of postoperative cognitive dysfunction (POCD) in the Group A was significantly lower than that in the Group B, and the difference had statistical significance (p < .05).ConclusionDexmedetomidine can ameliorate the postoperative cognitive functions of elder patients who received the laparoscopic ovarian cystectomy under general anesthesia, and effectively decrease the incidence rate of POCD without any obvious or severe adverse reaction. Thus, it can serve as a kind of adjuvant drug for general anesthesia in clinical practice.     

Efficacy and Safety of Linagliptin in Black/African American Patients with Type 2 Diabetes: A 6-Month,Randomized, Double-Blind,Placebo-Controlled Study

ObjectiveAlthough black/African American individuals are disproportionately affected by type 2 diabetes, there is scant clinical trial information available on antidiabetes therapies in this group. We compared linagliptin with placebo in black/African American adults who were treatment-naïve or receiving one oral antidiabetes drug.MethodsOf 226 patients randomized to 24 weeks’ linagliptin 5 mg/day or placebo, 208 had baseline and at least one on-treatment glycated hemoglobin (HbA_1c) measurement. Mean baseline HbA_1c was 8.6% in the linagliptin group (n = 98) and 8.68% in the placebo group (n = 110). The primary outcome was change in HbA_1c from baseline to week 24.ResultsBy week 24, mean HbA_1c changes were − 0.84% with linagliptin and − 0.25% with placebo (treatment difference, − 0.58%; P < .001), and more patients in the linagliptin group achieved HbA_1c < 7.0% (26.8% vs. 8.3%; P = .001) or an HbA_1c reduction ≥ 0.5% (54.1% vs. 30.0%; P < .001). Mean weight loss was − 1.1 kg in both groups. During the treatment period, 8 of 98 linagliptingroup patients and 17 of 110 placebo-group patients required rescue therapy (odds ratio, 0.5; P = .14). For postprandial glucose, values were available for few patients (11 placebo, 10 linagliptin), and thus the between-group difference was associated with wide confidence intervals (CIs) (difference, − 1.97 mg/dL; 95% CI, − 53.80 to 49.86; P = .94). In the overall study population, a similar proportion of patients in both groups had adverse events (58.5% vs. 61.7%); most events were mild or moderate and considered unrelated to study drug. Investigator-defined hypoglycemia was rare (3 linagliptin-group patients and 1 placebogroup patient), with no severe events (requiring external assistance).ConclusionThis study confirms that linagliptin is efficacious and well tolerated in black/African American patients with type 2 diabetes. (Endocr Pract. 2014;20: 412-420)     

阻塞性睡眠呼吸暂停低通气综合征患者MPV、PDW、RDW的相关性及其临床意义

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的平均血小板体积(MPV)、血小板分布宽度(PDW)、红细胞分布宽度(RDW)的相关性及其临床意义。方法:选取2016年4月-2018年4月我院收治的OSAHS患者105例,对所有入组患者的诊疗资料、检查数据进行综合性的整理与分析。将所有入组的OSAHS患者按呼吸暂停通气不足指数(AHI)分成轻中度组45例(5次/h≤AHI30次/h)和重度组60例(AHI≥30次/h)。观察比较两组的AHI指数、脉搏氧饱和度低于90%(TSpO_290%)时间及最低血氧饱和度(LSaO_2),比较两组的MPV、PDW及RDW表达情况并探讨AHI与MPV、PDW及RDW之间的相关性。结果:重度组AHI、TSpO_290%时间高于轻中度组,差异有统计学意义(P0.05);重度组LSaO_2低于轻中度组,差异有统计学意义(P0.05)。重度组MPV、PDW显著高于轻中度组,差异有统计学意义(P0.05);重度组RDW表达水平略高于轻中度组,但差异无统计学意义(P0.05)。相关性分析结果显示,AHI与MPV、PDW之间存在正相关性(r=0.601,0.587;P=0.021,0.030),AHI与RDW之间不存在相关性(r=0.024,P=0.071)。结论:OSAHS患者的病情发展情况与MPV、PDW之间存在独立的正相关性,但是与RDW之间不存在相关性。     

Effect of latanoprost on intraocular pressure,visual acuity and C-reactive protein

ObjectiveTo investigate the effect of latanoprost on intraocular pressure (IOP), visual acuity and C-reactive protein (CRP) in patients with primary open-angle glaucoma (POAG).MethodsA total of 163 POAG patients (266 eyes) admitted to our hospital from February 2015 to July 2017 were selected and divided into observation group (81 cases, 132 eyes, latanoprost eye drops) and control group (82 cases, 134 eyes, timolol maleate eye drops) according to different treatment plans. The clinical efficacy of the two groups after treatment was evaluated. The IOP, visual acuity and CRP level were compared between the two groups before and after treatment. Then the adverse reactions of the two groups were observed and recorded.ResultsAfter treatment, the total effective rate was 92.59% (75 cases) in the observation group and was 80.49% (66 cases) in the control group, with statistic difference between groups (P < 0.05); The IOP, visual acuity and CRP level between the two groups before treatment showed no statistic difference, the mentioned three indexes of the two groups were significantly improved after treatment, and statistic difference was found before and after treatment (P < 0.05); Moreover, the above three indicators had statistically significant differences between groups after treatment (P < 0.05); The difference of intraocular pressure and visual acuity between the two groups before and after treatment were statistically different (P < 0.05); After treatment, the incidence of adverse reactions in the observation group such as allergy, vomiting, breathlessness and tachycardia were not significantly different from those in the control group (P > 0.05).ConclusionLatanoprost can improve IOP, visual acuity, and CRP levels. It improves eye hemodynamics, and has significant efficacy in treating primary open-angle glaucoma. Also, it has good security.     

慢性阻塞性肺疾病患者超声监测膈肌增厚率与肺功能的相关性

摘要 目的：探讨慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者超声监测膈肌增厚率与肺功能的相关性。方法：2019年1月到2020年12月选择在本院诊治的COPD患者72例作为COPD组,同期选择在本院体检的健康人72例作为对照组。采用超声监测两组入选者的膈肌增厚率,使用肺功能测定仪测定呼气流量峰值(peak expiratory flow,PEF)、第1 秒用力呼气容积占预计值百分比(Forced Expiratory Volume in the first second,FEV₁)、肺活量25 %时用力呼气流速(Vmax25%,V25)、肺活量50 %时用力呼气流速(Vmax50%,V50)、肺活量75 %时用力呼气流速(Vmax75%,V75)等指标并进行相关性分析。结果：COPD组的膈肌增厚率低于对照组,对比差异有统计学意义(P<0.05)。COPD组的FEV₁、PEF、V25、V50、V75值都低于对照组,对比差异都有统计学意义(P<0.05)。在COPD组患者中,Pearson相关分析显示膈肌增厚率与FEV₁、PEF、V25、V50、V75都存在正相关性(P<0.05)。Logistic回归分析显示FEV₁、PEF、V25、V50、V75为影响膈肌增厚率的重要影响因素P<0.05)。结论：COPD患者超声监测可显示膈肌增厚率与肺功能降低,两者存在相关性,肺功能下降也是导致患者膈肌增厚率降低的重要危险因素。     

Effects of human chorionic gonadotropin combined with clomiphene on Serum E2, FSH,LH and PRL levels in patients with polycystic ovarian syndrome

ObjectiveEffects of human chorionic gonadotropin combined with clomiphene on serum E₂, FSH, LH and PRL levels in patients with polycystic ovarian syndrome were analyzed.Methods90 patients with polycystic ovarian syndrome treated from January 2015 to March 2016 were randomly and evenly divided into control group and observation group. Patients in the control group were only treated with clomiphene. On the basis of the treatment in control group, human chorionic gonadotropin was added in the treatment of observation group. The changes of E₂, FSH, LH, PRL levels were compared between two groups before and after the treatment. Clinical curative effects of patients in the two groups was evaluated. Adverse reactions during treatment in two groups were observed and recorded. The incidence of adverse reactions was calculated.ResultsSerum E₂, FSH, LH and PRL levels in the two groups decreased significantly after treatment compared with that before treatment. The difference is statistical significant (P < 0.05). After the treatment, E₂, FSH, LH and PRL levels in the observation group were lower than that in the control group and the difference is statistical significant (P < 0.05). Total effective rate was 64.44% in the control group and 93.33% in the observation group. There were statistically significant difference in clinical curative effects in the two groups (P < 0.05). Different degrees of adverse reactions were found in both groups during treatment, such as nausea, vomiting, anorexia, liver dysfunction. There were 2 cases of nausea, 2 cases of vomiting, 3 cases of anorexia and 1 case of liver dysfunction from the 45 patients in control group. The total incidence of adverse reactions was 17.78% (8/45). There were 1 case of nausea, 1 case of vomiting, 1 case of anorexia and no liver dysfunction from the 45 patients in observation group. The total incidence of adverse reactions was 6.67% (3/45). The total incidence of adverse reactions in the observation group was significantly higher than that in the control group and the difference was not statistically significant (P > 0.05).ConclusionCombined use of human chorionic gonadotropin can significantly reduce serum E₂, FSH, LH and PRL levels, improve clinical curative effects and reduce the incidence of adverse reactions. Human chorionic gonadotropin has high application value on the treatment of polycystic ovary syndrome.     

Control of the rate of phosphocreatine resynthesis after exercise in trained and untrained human quadriceps muscles

We examined the effect of differences in exercise intensity on the time constant (t _c) of phosphocreatine (PCr) resynthesis after exercise and the relationships betweent _c and maximal oxygen uptake (VO_2max) in endurance-trained runners (n = 5) and untrained controls (n = 7) (average VO_2max = 66.2 and 52.0 ml · min^–1 · kg^–1, respectively). To measure the metabolism of the quadriceps muscle using phosphorus nuclear magnetic resonance spectroscopy, we developed a device which allowed knee extension exercise inside a magnet. All the subjects performed four types of exercise: light, moderate, severe and exhausting. The end-exercise PCr: [PCr + inorganic phosphate (P_i)] ratio decreased significantly with the increase in the exercise intensity (P < 0.01). Although there was little difference in the end-exercise pH, adenosine diphosphate concentration ([ADP]) and the lowest intracellular pH during recovery between light and moderate exercise, significant changes were found at the two higher intensities (P < 0.01). These changes for runners were smaller than those for the controls (P < 0.05). The _c remained constant after light and moderate exercise and then lengthened in proportion to the increase in intensity (P < 0.05). The runners had a lowert _c at the same PCr and pH than the controls, particularly at the higher intensity (P < 0.05). There was a significant correlation betweent _c and [ADP] in light exercise and betweent _c and both end-exercise PCr and pH in severe and exhausting exercise (P < 0.05). The threshold of changes in pH andt _c was a PCr: (PCr + P_i) ratio of 0.5. There was a significant negative correlation between the VO_2max andt _c after all levels of exercise (P<0.05).However, in the controls a significant correlation was found in only light and moderate exercise (P < 0.05). These findings suggest the validity of the use oft _c at an end-exercise PCr:(PCr + P_i) ratio of more than 0.5 as a stable index of muscle oxidative capacity and the correlation between local and general aerobic capacity. Moreover, endurance-trained runners are characterized by the faster PCr resynthesis at the same PCr and intracellular pH.     

不同剂量艾司氯胺酮对腹腔镜全子宫切除术患者术后疼痛和情绪状态的影响

摘要 目的：探讨不同剂量艾司氯胺酮对腹腔镜全子宫切除术患者术后疼痛和情绪状态的影响。方法：按照随机数表法,选择2022年1月至2023年4月我院行腹腔镜全子宫切除术患者120例分为对照组（A组,n=40）、艾司氯胺酮0.25 mg/kg组（B组,n=40）、艾司氯胺酮0.5 mg/kg组（C组,n=40）。比较三组组围术期指标、术后1、4、8、24 h和48 h的疼痛评定数字量表（NRS）评分及术前1天（PRE1）、术后第1天（POD1）、术后第2天（POD2）的焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分、血流动力学指标及不良反应。结果：B组和C组术后24 h舒芬太尼镇痛药物用量、补救镇痛例数小于A组,A组、B组苏醒时间、拔管时间短于C组（P＜0.05）。B组、C组术后1 h的NRS评分低于A组（P＜0.05）,B组术后4 h、8 h、24 h的NRS评分低于A组,术后4 h、8 h的NRS评分低于C组（P＜0.05）。与组内PRE1相比,三组POD1的SAS、SDS评分均升高（P＜0.05）。B组、C组POD1、POD2的SAS、SDS评分均低于A组,且C组低于B组（P＜0.05）。与组内PRE1相比,A组POD2的SAS、SDS评分升高（P＜0.05）。与组内PRE1相比,B组POD2的SDS与C组POD2的SAS、SDS均降低（P＜0.05）。在T3时刻,B组和C组的平均动脉压（MAP）、心率（HR）低于A组（P＜0.05）。B组和C组术后恶心呕吐发生率低于A组（P＜0.05）;A组和B组术后头晕、苏醒延迟的发生率低于C组（P＜0.05）;三组术后苏醒期躁动和呼吸抑制的差异无统计学意义（P＞0.05）。结论：0.25 mg/kg的艾司氯胺酮对减轻腹腔镜全子宫切除术患者术后疼痛,减少阿片类药物用量,改善负面情绪的临床效果更佳。     

Preadmission Glycemic Control and Changes to Diabetes Mellitus Treatment Regimen After Hospitalization

ObjectiveTo evaluate treatment patterns associated with diabetes medication regimen changes after hospitalization on the basis on preadmission hemoglobin A_1c levels.MethodsIn this retrospective database analysis, patients with a diabetes diagnosis, hospitalization, and documented hemoglobin A_1c level within the 90 days leading up to hospital admission were identified in an administrative claims database. Treatment regimens were assessed before and after hospitalization. The proportion of patients who had progression, reduction, or no change in therapy was compared across hemoglobin A_1c subgroups: hemoglobin A_1c < 7.0%, hemoglobin A_1c 7.0%-7.9%, and hemoglobin A_1c ≥ 8.0%.ResultsFour hundred patients were included (192 in hemoglobin A_1c < 7.0% group, 94 in hemoglobin A_1c 7.0% 7.9% group, and 114 in hemoglobin A_1c ≥ 8.0% group). Demographically, hemoglobin A_1c subgroups did not differ significantly (mean age, 57 years; 47.5% male). With respect to therapeutic regimen overall, 28%, 24%, and 48% of patients experienced progression, reduction, and no change, respectively. Across hemoglobin A_1c subgroups, 37.7% of patients in the hemoglobin A_1c ≥ 8.0% subgroup had therapy progression compared with 26% and 20.2% in the hemoglobin A_1c < 7.0% and hemoglobin A_1c 7.0%-7.9% subgroups, respectively (P = .032 and P = .006, respectively). Within the progression category, progression via insulin initiation was significantly higher in the hemoglobin A_1c ≥ 8.0% subgroup (55.8%) than in the hemoglobin A_1c < 7.0% subgroup (16%, P < .001), but not significantly higher than in the hemoglobin A_1c 7.0%-7.9% subgroup (36.8%, P = .084). In the hemoglobin A_1c ≥ 8.0% subgroup, a lower percentage of patients, 35.1%, experienced no therapy change than in both the hemoglobin A_1c < 7.0% subgroup (52.6%) and the hemoglobin A_1c 7.0%-7.9% subgroup (54.3%) (P = .003 and P = .006, respectively). There was no difference between subgroups in reduction of therapy.ConclusionsA higher proportion of patients with a hemoglobin A_1c level ≥ 8.0% had progression of their antidiabetes therapy after hospitalization and fewer patients had no change in therapy than those in lower hemoglobin A_1c subgroups. These data suggest that clinicians may be using hemoglobin A_1c measurements to guide discharge planning treatment decisions. (Endocr Pract. 2012;18:371-375)     

Effect of Glargine Insulin Delivery Method (Pen Device Versus Vial/Syringe) on Glycemic Control and Patient Preferences in Patients with Type 1 and Type 2 Diabetes

ObjectiveTo evaluate the effects of two different glargine insulin delivery methods (pen device vs. vial/ syringe) on glycemic control and patient preferences in a randomized, open-label, crossover, comparative effectiveness study.MethodsThirty-one patients discharged from the hospital were recruited for this study. In the hospital, all patients were treated with a basal-bolus insulin regimen. Upon discharge, 21 patients received glargine by pen device for 3 months and were then switched to vial/syringe for the next 3 months (group 1). Group 2 consisted of 10 patients discharged on vial/syringe and converted to pen device after 3 months. Hemoglobin A_1c (HbA_1c) was measured at enrollment and at 3 and 6 months. A questionnaire assessing patient preference was administered at 3 and 6 months.ResultsGroups 1 and 2 had similar baseline HbA_1c (10.7 ± 2.2% and 11.2 ± 2.5%, respectively) and similar reduction in HbA_1c at 3 months (7.8 ± 1.7% and 7.3 ± 1.4%, respectively; P < .001 vs. baseline). However, after crossover, the changes in HbA_1c from 3 to 6 months were significantly different between groups. HbA_1c increased to 8.5 ± 2.0% at 6 months in group 1 after switching to the vial/syringe but remained unchanged (7.1 ± 1.6%) in group 2 after switching to a pen device (P < .01, group 1 vs. group 2). Patient questionnaires after each phase of the trial revealed that patients found the pen device more convenient and were more likely to recommend this insulin delivery method to someone else.ConclusionPatients switching to a glargine pen device achieved lower HbA_1c at the 6-month follow-up. Patients in both groups overwhelmingly preferred glargine pens over vials/syringes. (Endocr Pract. 2014;20:536-539)     

腹腔镜与传统开腹手术对胃癌临床疗效、术后并发症及免疫功能的影响比较

目的:探讨腹腔镜与传统开腹手术治疗胃癌的临床疗效、安全性及对患者免疫功能的影响。方法:选择2012年3月至2014年3月在我院行胃癌D2根治术的胃癌患者92例并随机分为两组,开腹组(A组)44例接受传统开腹手术,腹腔镜组(B组)48例接受腹腔镜辅助胃癌根治术,观察和比较两组患者的手术情况以及手术前后患者免疫功能的变化,比较两组患者围术期不良反应的发生情况及临床疗效。结果:B组患者术中切口长度、出血量明显优于A组患者(P0.05),且B组患者较A组患者术后排气时间以及疼痛缓解情况明显较好(P0.05);两组患者接受手术前后,机体的免疫功能有所变化,B组患者术后24hCD3~+、CD4~+、CD8~+、CD4~+/CD8~+以及NK细胞相对活性等细胞免疫指标明显高于A组(P0.05),体液免疫指标IgM、IgG以及IgA等免疫球蛋白明显高于A组;两组患者术中并发症的发生率差异无统计学意义(P0.05),B组患者术后并发症的发生率与A组比较明显降低,且差异具有统计学意义(P0.05)。结论:腹腔镜辅助胃癌D2根治术对胃癌患者术中临床疗效有显著改善作用,可降低对机体免疫功能的影响并提高治疗的安全性。